Introduction: Fatigue during the acute phase following stroke has been shown to predict long-term physical health, specifically increased bodily pain and poorer self-rated general health. The aim of this analysis was to determine whether acute phase fatigue also predicts patients’ level of functioning with respect to activities of daily living (ADL) 18 months after first stroke. Methods: Patients with first-ever stroke (n=88) were recruited upon admission at two hospitals in Norway. Patients were assessed within 2 weeks following admission and at 18 months using the Barthel Index of Activities of Daily Living (BI), Fatigue Severity Scale, and Beck Depression Inventory II. The relationship between acute-phase fatigue and later ADL impairment (BI<20) was evaluated using multivariate logistic regression analysis controlling for relevant covariates and acute-phase ADL functioning. Results: Acute-phase fatigue was associated with ADL impairment at 18-month follow-up (p=.006), even when controlling for other predictors of ADL functioning, including age, gender, baseline work status, and acute-phase depressive symptoms and ADL function. Examining the reverse relationship, acute-phase ADL function was unrelated to fatigue 18 months after stroke. Conclusions: Our study indicates that acute-phase fatigue may be an independent risk factor for ADL impairment 18 months after stroke. The finding indicates that effective treatments for post-stroke fatigue both in the acute-phase and later in the recovery period may contribute to better stroke rehabilitation.

ABSTRACT The purpose of this pilot study was to describe and explore a group-based multifaceted intervention for patients with fatigue after acquired brain injury (ABI). We hypothesised that post-intervention changes would result in reduced fatigue, in addition to improved emotional health, sleep and attentional control. Eight subjects with traumatic brain injury (n = 3) and cerebrovascular insults (n = 5) were included. Inclusion was based upon the presence of fatigue complaints. The participants received 36 hours of intervention. Changes related to fatigue, emotional health and sleep was assessed with self-rating measures. Additionally, a neuropsychological test (Conners’ Continuous Performance Test II) was included as a measure of attentional control. All subjects were assessed at baseline, post-intervention, and at 3 and 9 months follow-up. Findings indicated reduced fatigue levels (post-intervention and 3 months follow-up), anxiety (9 months follow-up), and daytime sleepiness (3 and 9 months follow-up). Pilot results suggest that multifaceted group-based interventions may have the potential to alleviate symptoms of fatigue, anxiety and sleepiness after ABI. At an individual level, a low load of psychological distress, insomnia symptoms, dysexecutive symptoms, in addition to a strong sense of self-efficacy, may be central in order to reduce levels of fatigue. KEYWORDS: Fatigue, cognitive rehabilitation, brain injury, goal management, self-efficacy

PURPOSE: The aim of this study was to describe the course of post-stroke depression (PSD) during the first 18 months after first-ever stroke and to examine differences in the course of depressive symptoms in relation to patient demographic and clinical characteristics in the acute phase. METHODS: As part of a longitudinal cohort study, data were collected from medical records and in face-to-face interviews using standardized questionnaires within 15 days after stroke and 6, 12 and 18 months later. The sample consisted of 94 patients with first-ever stroke. PSD was measured with the Beck Depression Inventory II. Repeated measures analysis of variance was used to evaluate the course of depressive symptoms over time and in relation to demographic and clinical variables. RESULTS: Depression levels were stable during the 18 months after first-ever stroke. However, depression scores were significantly higher among patients who had lower physical functioning in the acute phase, were living alone or were not employed at the time of stroke. CONCLUSIONS: Several demographic and acute phase factors were associated with a more severe PSD course following stroke. Psychosocial support that begins in the acute phase and continues throughout the rehabilitation process may be helpful in improving both physical and psychological outcomes following stroke. Implications for Rehabilitation Depression levels are stable during the first 18 months after first-ever stroke. The course of post-stroke depression is related to the level of physical functioning in the acute phase, whether the stroke survivors live alone and their employment status at the time of stroke. Psychological support that begins in the acute phase and continues throughout the rehabilitation process may be helpful in improving both physical and psychological outcomes following stroke.

CONTEXT: To accurately investigate diurnal variations in fatigue, a measure needs to be psychometrically sound and demonstrate stable item function in relationship to time of day. Rasch analysis is a modern psychometric approach that can be used to evaluate these characteristics. OBJECTIVES: To evaluate, using Rasch analysis, the psychometric properties of the Lee Fatigue Scale (LFS) in a sample of oncology patients. METHODS: The sample comprised 587 patients (mean age 57.3±11.9 years, 80% female) undergoing chemotherapy for breast, gastrointestinal, gynecological, or lung cancer. Patients completed the 13-item LFS within 30 minutes of awakening (i.e., morning fatigue) and prior to going to bed (i.e., evening fatigue). Rasch analysis was used to assess validity and reliability. RESULTS: In initial analyses of differential item function, eight of the 13 items functioned differently depending on whether the LFS was completed in the morning or in the evening. Subsequent analyses were conducted separately for the morning and evening fatigue assessments. Nine of the morning fatigue items and 10 of the evening fatigue items demonstrated acceptable goodness-of-fit to the Rasch model. Principal components analyses indicated that both morning and evening assessments demonstrated unidimensionality. Person separation indices indicated that both morning and evening fatigue scales were able to distinguish four distinct strata of fatigue severity. CONCLUSION: Excluding four items from the morning fatigue scale and three items from the evening fatigue scale improved the psychometric properties of the LFS for assessing diurnal variations in fatigue severity in oncology patients.

Abstract Objectives This pilot study aimed to describe the sleep of partners and other family caregivers prior to and in the first year after a hospice patient's death. The study also evaluated the feasibility of the study protocol and determined the effect sizes in preparation for a full-scale study. Design The pilot study used a longitudinal, descriptive and comparative design. Setting and participants Participants included primary family caregivers of patients admitted to a hospice in Oslo, Norway. Primary outcome Caregiver sleep was measured subjectively with the Pittsburgh Sleep Quality Index (PSQI) and objectively using wrist actigraphy for 4 nights and 3 days at three different times: during the hospice stay, and at 6 and 12 months after the patient's death. Results 16 family caregivers (10 partners and 6 other family members) completed the 1-year study protocol. Overall, sleep quality and quantity were stable over time and at each assessment, approximately half of the sample had poor sleep quality, both by self-report and objective measures. However, the sleep trajectories differed significantly over time, with older caregivers (≥65 years) having significantly longer sleep durations than younger caregivers (<65 years). Furthermore, sleep quality also differed over time depending on the caregiver's relationship to the patient, with partner caregivers having significantly worse sleep quality than other family caregivers. Conclusions Caring for a dying family member is known to interfere with sleep, yet little is known about bereaved caregivers. The results of this pilot study demonstrate the feasibility of the longitudinal study protocol and indicate that sleep problems are common for caregivers and continue into the bereavement period, particularly for partner caregivers. The caregiver's relationship to the patient may be an important factor to consider in future studies.

Background and purpose — Functional limitations after total knee arthroplasty (TKA) are common. In this longitudinal study, we wanted to identify subgroups of patients with distinct trajectories of pain-related interference with walking during the first year after TKA and to determine which demographic, clinical, symptom-related, and psychological characteristics were associated with being part of this subgroup. Patients and methods — Patients scheduled for primary TKA for osteoarthritis (n = 202) completed questionnaires that evaluated perception of pain, fatigue, anxiety, depression, and illness on the day before surgery. Clinical characteristics were obtained from the medical records. Interference of pain with walking was assessed preoperatively, on postoperative day 4, and at 6 weeks, 3 months, and 12 months after TKA.

Objectives Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA. Methods Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records. Results Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery. Discussion Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients’ perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes.

Aims and objectives To explore experiences of nurses implementing and using the Modified Early Warning Score (MEWS) and a Mobile Intensive Care Nurse (MICN) providing 24-hour on-call nursing support. Background To secure patient safety in hospital wards, nurses may increase the quality of care using a tool to detect the failure of vital functions. Possibilities for support can be provided through on-call supervision from a qualified team or nurse. Design This exploratory qualitative investigation used focus group interviews with nurses from two wards of a university hospital in Norway. Methods A purposive sample of seven registered nurses was interviewed in focus groups. A semi-structured guide and an inductive thematic analysis were used to identify interview themes. Results Three themes emerged: (1) experiences with the early recognition of deterioration using the MEWS, (2) supportive collaboration and knowledge transfer between nurses and (3) a “new” precise language using the score for communicating with physicians. The use of scores and support were perceived as improving care for deteriorating patients and for supporting the collaboration of nurses with other professionals. Conclusion In our study, nurses described increased confidence in the recognition of deteriorating patients and in the management of such situations. The non-critical attitude, supportive communication and interactive learning according to the MICN were essential elements for success. Keywords Clinical deterioration; Critical care; Qualitative research; Vital sign monitoring

Genes involved in circadian regulation, such as circadian locomotor output cycles kaput [CLOCK], cryptochrome [CRY1] and period [PER], have been associated with sleep outcomes in prior animal and human research. However, it is unclear whether polymorphisms in these genes are associated with the sleep disturbances commonly experienced by adults living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Thus, the purpose of this study was to describe polymorphisms in selected circadian genes that are associated with sleep duration or disruption as well as the sleep-wake rhythm strength and phase timing among adults living with HIV/AIDS. A convenience sample of 289 adults with HIV/AIDS was recruited from HIV clinics and community sites in the San Francisco Bay Area. A wrist actigraph was worn for 72 h on weekdays to estimate sleep duration or total sleep time (TST), sleep disruption or percentage of wake after sleep onset (WASO) and several circadian rhythm parameters: mesor, amplitude, the ratio of mesor to amplitude (circadian quotient), and 24-h autocorrelation. Circadian phase measures included clock time for peak activity (acrophase) from actigraphy movement data, and bed time and final wake time from actigraphy and self-report. Genotyping was conducted for polymorphisms in five candidate genes involved in circadian regulation: CLOCK, CRY1, PER1, PER2 and PER3. Demographic and clinical variables were evaluated as potential covariates. Interactions between genotype and HIV variables (i.e. viral load, years since HIV diagnosis) were also evaluated. Controlling for potentially confounding variables (e.g. race, gender, CD4+ T-cell count, waist circumference, medication use, smoking and depressive symptoms), CLOCK was associated with WASO, 24-h autocorrelation and objectively-measured bed time; CRY1 was associated with circadian quotient; PER1 was associated with mesor and self-reported habitual wake time; PER2 was associated with TST, mesor, circadian quotient, 24-h autocorrelation and bed and wake times; PER3 was associated with amplitude, 24-h autocorrelation, acrophase and bed and wake times. Most of the observed associations involved a significant interaction between genotype and HIV. In this chronic illness population, polymorphisms in several circadian genes were associated with measures of sleep disruption and timing. These findings extend the evidence for an association between genetic variability in circadian regulation and sleep outcomes to include the sleep-wake patterns experienced by adults living with HIV/AIDS. These results provide direction for future intervention research related to circadian sleep-wake behavior patterns.

Aim: To translate the Quality of Life in Late-Stage Dementia (QUALID) Scale into Norwegian, and to evaluate the test-retest reliability and validity of the scale. Method: QUALID was translated according to standardised procedures. Residents with dementia living in nursing homes were included in the study and assessed using QUALID, Cornell Scale for Depression in Dementia, Neuropsychiatric Inventory, Physical Self-Maintenance Scale and Clinical Dementia Rating Scale. Results: Cronbach's α of QUALID was 0.79. In the reliability study, the intra-class correlation was 0.83. The validity study showed a strong association between depressive symptoms and QUALID, and a moderate association between QUALID and assessments of level of functioning and agitation. Conclusions: The Norwegian version of QUALID is a reliable and valid scale for assessing quality of life in nursing home residents with dementia.

Steindal, Simen Alexander; Bredal, Inger Schou; Ranhoff, Anette Hylen; Sørbye, Liv Wergeland & Lerdal, Anners (2015). The last three days of life: A comparison of pain management in the young old and the oldest old hospitalised patients using the Resident Assessment Instrument for Palliative Care. International Journal of Older People Nursing.
ISSN 1748-3735.
10(4), s 263- 272 . doi:
10.1111/opn.12076

Background The Beck Depression Inventory-II (BDI-II) is often used to assess depressive symptoms among stroke patients, but more evidence is needed regarding its psychometric properties in this population. The purpose of this study was to assess the BDI-II׳s psychometric properties using a Rasch model application in a sample of patients 6 months after a first clinical stroke. Methods Data were collected prospectively from patient medical records and from questionnaires (with assistance if needed) as a part of a longitudinal study of poststroke fatigue. Data from the 6-month follow-up were used in this analysis. The sample consisted of 106 patients with first-ever stroke recruited from two Norwegian hospitals between 2007 and 2008. Depressive symptoms were measured with the BDI-II. Rasch analysis was used to assess the BDI-II׳s psychometric properties in this sample. Results Five BDI-II items did not demonstrate acceptable goodness-of-fit to the Rasch model: items 10 (crying), 16 (changes in sleep), 17 (irritability), 18 (changes in appetite), and 21 (loss of interest in sex). If these 5 items were removed, the resulting 16-item version not only had fewer items, it also had better internal scale validity, person-response validity, and person-separation reliability than the original 21-item version in this sample of stroke survivors. Limitations The study did not include a clinical evaluation of depression.

Nutritional Risk Screening (NRS 2002) is associated with pressure ulcer in a hospital population Rationale: The objective in this study was to describe the prevalence of pressure ulcer (PU) and risk of malnutrition in a hospital population, in addition to examine whether Nutritional Risk Screening 2002 (NRS 2002) would be associated with the presence of PU in hospitalized patients. Methods: A cross-sectional study was conducted on 10 screening days (2012-2014) in a Norwegian hospital. Including patients (≥18 years) admitted to medical or elective orthopedic surgical wards and excluding patients admitted to Hospice, intensive care unit, cognitively impaired and patients not able to read Norwegian. Initial NRS 2002 and skin examinations were conducted by ward nurses and nursing students, using European Pressure Ulcer Advisory Panel classification (Stage I-IV). A registered clinical dietician conducted all final NRS 2002 screenings. SPSS version 22.0 and p<0.05 was used for all statistical analyses. Results: Study population included 651 patients, with complete NRS 2002 screening data and skin examinations. The NRS 2002 screening identified 34% at risk of malnutrition. PU prevalence was 8% and associated with age ≥70 years, body mass index (BMI) below 20 and hospitalization in the medical department. Both initial and final NRS 2002 revealed higher presence of PU (OR=2.58 and 2.55, respectively) than low nutritional risk. The initial screening items “Is BMI<20?” (OR= 2.73) and “Reduced dietary intake past week?” (OR=1.91) were strongly associated to PU, as was a composite item of “Reduced dietary intake past week OR Weight loss past 3 months”(OR= 2.75). Conclusion: This study shows that NRS 2002 (initial and final screening) was associated with PU in hospitalized patients. Initial screening items were strongly associated with PU and might be used for detecting patients at risk of malnutrition and PU. Conflict of interest: None.

Background and Aims: Caring for a dying family member is known to interfere with sleep, yet little is known about bereaved caregivers. This pilot study aimed to describe the sleep of partners and other family caregivers during the first year after a hospice patient’s death. Methods: The pilot study used a longitudinal, descriptive, comparative design. Participants included primary family caregivers of patients admitted to a hospice in Norway. Caregiver sleep was measured subjectively with the Pittsburgh Sleep Quality Index (PSQI) and objectively using wrist actigraphy for 3 days and nights at three different times: during the hospice stay, and at 6 and 12 months after the patient’s death. Results: Sixteen family caregivers (10 partners and 6 other family members) completed the 1-year study protocol without difficulty. Overall, sleep quality and quantity were stable over time, and at each assessment, approximately half of the sample had poor sleep quality, both by self-report and objective measures. However, the sleep trajectories differed significantly over time, with older caregivers (>65 years) having significantly longer sleep durations than younger caregivers (<65 years). Furthermore, sleep quality also differed over time depending on the caregiver’s relationship to the patient, with partner caregivers having significantly worse sleep quality than other family caregivers over time. Conclusion: Significance of results demonstrate feasibility of the longitudinal study protocol and indicate that sleep problems are common for caregivers and continue into the bereavement period, particularly for partner caregivers. The caregiver’s relationship to the patient may be an important factor to consider in future studies.